Claims Adjuster Workers Compensation

DESCRIPTION:
NV license mandatory.

PRIMARY PURPOSE: To analyze mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Manages workers compensation claims determining compensability and benefits due on long term indemnity claims monitors reserve accuracy and files necessary documentation with state agency.
• Develops and manages workers compensation claims action plans to resolution coordinates return-to-work efforts and approves claim payments.
• Approves and processes assigned claims determines benefits due and manages action plan pursuant to the claim or client contract.
• Manages subrogation of claims and negotiates settlements.
• Communicates claim action with claimant and client.
• Ensures claim files are properly documented and claims coding is correct.
• May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
• Maintains professional client relationships.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.
• Supports the organizations quality program(s).
• Travels as required.

QUALIFICATIONS
Education & Licensing
Bachelors degree from an accredited college or university preferred.

Experience
Four (4) years of claims management experience or equivalent combination of education and experience required.

Skills & Knowledge

• Working knowledge of regulations offsets and deductions disability duration medical management practices and Social Security and Medicare application procedure as applicable to line of business
• Excellent oral and written communication including presentation skills
• PC literate including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skill
• Good interpersonal skills
• Excellent negotiation skills
• Ability to work in a team environment
• Ability to meet or exceed Service Expectations